ptsd Depression/Adjustment disorder claim

[Scotter04]

Hi All,

I've got a question about submitting a depression/adjustment disorder claim on ebenennies.

When I submitted the claim to include sleep disturbances and anxiety. Hit save and continue and the next page said I claimed Ptsd.  It gave me the option of answering the questions or not.  

So, is this typical for depression/adjustment disorder?  If so, do I answer the questions or if not, skip the questions?  Any help would be appreciated.

Hope everyone is having a great weekend.

Scotter

[Kgosi]

Tough question so let me start with this. In order to be service connected for any disability you need three things. 1, A service connected event. 2. A bridge from that service connected event to your current disability. And 3. A current diagnosis of a disability. Now, there are exceptions to the above if you got out of service within the past year, or if the condition is presumptive, which mental health issues are not presumptive.

So, I would suggest filling out the PTSD questionnaire. Many people recognize they have depression or some other mental health problem, but lack the training to identify the source. Depression and anxiety can be disabilities in themselves, but they can also be symptoms of a more complex issue of PTSD.  

Lastly, did you suffer from a traumatic event while in the military, and is it recorded in your service records? If so, your symptoms may qualify for a PTSD diagnosis. If there is no traumatic event recorded in your service records it makes it harder, but not impossible to obtain a service connected disability.

One more point... If you submit a claim for PTSD you will also need to submit VA Form 21-0781 and 21-0781a. Failure to submit them both with your initial claim will remove you from the Fully Developed Claim program.

[Scotter04]

LATEST UPDATE:

Had my C & P Exam the other day for Adjustment Disorder Secondary to my S/C'd Tinnitus.  The Examiner said it was more inline with Unspecified Anxiety Disorder and not the Adjustment Disorder my MH Doc said I had.  The Examiner wrote the Adjustment disorder as "The condition claimed is less likely than not (less than 50%
    probability) proximately due to or the result of the Veteran's service connected condition."  So my question is

So my question is...Obviously I still need to wait for the BBE but if/when I'm denied would I appeal and change the contention to " Unspecified Anxiety Disorder " or would I file a new claim under " Unspecified Anxiety Disorder secondary to my S/c'd Tinnitus"?

I have scrubbed and included my C & P Exam notes below.  Any feedback would be greatly appreciated.

 

                                Mental Disorders
                     (other than PTSD and Eating Disorders)
                        Disability Benefits Questionnaire  
   
    Is this DBQ being completed in conjunction with a VA 21-2507, C&P
Examination Request?   [X] Yes  [ ] No

                          
    1. Diagnosis
    ------------
    a. Does the Veteran now have or has he/she ever been diagnosed with a mental disorder(s)?
       [X] Yes  [ ] No
      
       ICD code: F41.9
      
       If the Veteran currently has one or more mental disorders that conform to
       DSM-5 criteria, provide all diagnoses:
      
       Mental Disorder Diagnosis #1: Unspecified Anxiety Disorder
       ICD code: F41.9
       Comments, if any:
         transient, moderately severe symptoms of anxiety (irritability,
         edginess, nervousness, panic symptoms with chest tightness, pressured
         breathing, sweatiness, heart palpatations, etc. that occur when he is
         around a lot of noise or when someone is hovering over him at his desk
         at work which makes him feel closed in, insomnia due primarily to
         tinnitus, muscle tension in back muscles, concentration/short-term
         memory problems, fatigue) that had onset after the military (approx 10
         years ago) and cause marked distress and mild impairment in
occupational
         and social functioning (due primarily to irritability and impatience at
         work and at home, fatigue, concentration/short-term memory issues)

    b. Medical diagnoses relevant to the understanding or management of the
       Mental Health Disorder (to include TBI): Obstructive Sleep apnea with
       C-PAP; Tinnitus
      

    2. Differentiation of symptoms
    ------------------------------
    a. Does the Veteran have more than one mental disorder diagnosed?
       [ ] Yes  [X] No
      
    c. Does the Veteran have a diagnosed traumatic brain injury (TBI)?
       [ ] Yes  [ ] No  [X] Not shown in records reviewed
      
    3. Occupational and social impairment
    -------------------------------------
    a. Which of the following best summarizes the Veteran's level of
occupational
       and social impairment with regards to all mental diagnoses? (Check only
       one)
      
       [X] Occupational and social impairment due to mild or transient symptoms
           which decrease work efficiency and ability to perform occupational
           tasks only during periods of significant stress, or; symptoms
           controlled by medication

    b. For the indicated level of occupational and social impairment, is it
       possible to differentiate what portion of the occupational and social
       impairment indicated above is caused by each mental disorder?
       [ ] Yes  [ ] No  [X] No other mental disorder has been diagnosed
      
    c. If a diagnosis of TBI exists, is it possible to differentiate what
portion
       of the occupational and social impairment indicated above is caused by
the
       TBI?
       [ ] Yes  [ ] No  [X] No diagnosis of TBI
      
                               Clinical Findings:
                               ------------------
    1. Evidence Review
    ------------------
    Evidence reviewed (check all that apply):
   
    [X] VA e-folder (VBMS or Virtual VA)

    2. History
    ----------
    a. Relevant Social/Marital/Family history (pre-military, military, and
       post-military):
      
         States he was born and raised in Nebraska, raised by both parents, and
         he has 2 younger brothers and one younger sister. States he had a good
         childhood, denies any childhood abuse or neglect, and states he had
good
         social skills, had a good number of friends as he was growing, played
         basketball and football in high school.

         He entered the Air Force in August 1990, had no unusual trouble
         adjusting to the military.

         States he has been married twice and divorced once, first marriage was
         from about 1999 to about 2009, has 2 sons from the marriage (ages 12
and
         10), shares custody of both, sees them every other weekend, facetimes
         with them during the week. States he has been married to his current
         wife for 7 years, and they have a 5 year old son together. States they
         currently own their own in Brimerton Washington, wife and youngest son
         lives in the home currently and he is in San Diego for work (has been
         gone since March, was able to go back home for several weeks in
         August/Sept, will be done with his job in San Diego around Christmas).
         States his marriage is "good", has good relationships with his
children.
         States he currently has a couple of friends he works with in San Diego,
         sometimes hangs out with them after work, also has friends elsewhere he
         stays in touch with via facebook. States he contacts his parents about
         once a month to let them know how he's doing, only talks with his
         siblings about every other year when he goes back to Nebraska to visit.
         States he is active in his church, and he enjoys golfing, spending time
         with his family, and doing outdoor activities (camping, hunting,
         fishing, etc.).
        
        
    b. Relevant Occupational and Educational history (pre-military, military,
and
       post-military):
      
         Premilitary Hx: States he had no major behavioral or disciplinary
         problems, got pretty good grades in school, graduated from high school
         on time. States he worked as a fertilizer salesman for his father and
         for farmers in the area during high school.

         Military Hx: Entered the Air Force in August 1990, honorably discharged
         in Oct 1999. MOS/Rate was Fuels Journeyman, highest rank/rank at
         discharge was E4. States he was reduced in rank one time in 1995 due to
         DUI but states he was able to recover rank over time after the DUI. He
         denies any other formal disciplinary problems, was awarded an air force
         commendation medal, 2 air force achievement medals, 2 air force
         outstanding unit awards, 2 good conduct medals, national defense
service
         medal, armed forces expeditionary medal, 3 southwest asia service
         medals, overseas short tour ribbon, 2 air force longevity service award
         ribbons, NCO professional military education graduate ribbon, and air
         force training ribbon.

         Combat Exposure: in Saudi Arabia in 1992 and 1994, but no combat
         exposure

         Postmilitary Hx: States that after the Air Force, he worked in a
         warehouse for circuit city until 2001, then got a job as a material
         handler for the Navy, is now a material handler project manager (for 4
         1/2 years), states the job can be stressful, but he likes his job,
feels
         he is good at his job, performs well. States his wife is currently a
         medical assistant.  
        
        
    c. Relevant Mental Health history, to include prescribed medications and
       family mental health (pr
e-military, military, and post-military):
      
         States he has no family hx of mental illness that he knows of, and he
         denies that he had any mental health problems or psychiatric treatment
         prior to the military.

         States he was sent to mental health after his DUI in 1995, had 2-3
         appointments with mental health and then 2-3 alcohol abuse treatment
         sessions, was diagnosed with alcohol abuse, had no other mental health
         treatment during the military. States he and his ex-wife had couples'
         counseling/therapy in about 2008 (a couple of sessions), also had
         marital therapy with his current wife and individual therapy sessions
         due to problems with his ex-wife interferring in their relationship.

         He had a mental health intake at the Puget Sound VA in Nov 2015, was
         diagnosed with adjustment disorder and other sleep/wake disorder, and
         had 5 individual therapy sessions through the Puget sound VA after the
         intake. Intake note from the puget sound VA dated Nov 6, 2015 states
         "Veteran presented to this initial PCMHI intake reporting that he
         experiences initial insomnia as a result of tinnitus. He also endorsed
         waking up 2-3x/night, but indicated that he is usually able to fall
         asleep within 15 minutes. Altogether, he reported getting between 3-5
         hours of sleep, and he endorsed feeling tired during the day. He also
         complained of irritability, indicating that he feels easily annoyed and
         snaps at people both at work and at home. This has led to marital
         conflict. Veteran also endorsed difficulty concentrating, short-term
         memory difficulties, and depressed mood. He stated that he is "getting
         tired of the tinnitus, sleepiness, insomnia, and I'm frustrated that
         it's interfering with me and my wife's relationship." Veteran also
         endorsed anxiety, describing frequent panic attacks when in a crowded
         room. These panic attacks involve tightness in his chest, an immediate
         urge to escape, increase HR, sweating, hot flashes, feeling faint,
         nausea, and his "mind racing about am I going crazy or is it going to
         get worse." He reported that these attacks last from 5 min-1 hour, and
         he copes with them by "trying to analyze and wait it out." He also
         engages in deep breathing to slow his heart rate down. He is confused
by
         the appearance of panic attacks, which began 6-7 years ago and have
         increased in frequency." "Veteran endorsed struggling with insomnia for
         approx. 15 years and indicated that the other MH symptoms he endorsed
         have slowly developed over the course of the last 10 years or so. He
was
         previously prescribed zolpidem, which was somewhat helpful. However, he
         reported that it still took a while to take effect at night, so he
         discontinued it."

         States he continues to have difficulty sleeping, which he feels is
         primarily due to "continuous tinnitus" (although he has been diagnosed
         with sleep apnea and is prescribed a C-PAP machine, states the machine
         is not very helpful, admits that sleep apnea might play a part in his
         sleep disturbance). States he has had transient, moderately severe
         symptoms of anxiety (irritability, edginess, nervousness, panic
symptoms
         with chest tightness, pressured breathing, sweatiness, heart
         palpatations, etc. that occur when he is around a lot of noise or when
         someone is hovering over him at his desk at work which makes him feel
         closed in, insomnia due primarily to tinnitus, muscle tension in back
         muscles, concentration/short-term memory problems, fatigue) that cause
         marked distress and irritability at work (states work colleagues in
         puget sound have heard about his verbal outbursts) and states it does
         not take much for him to "snap" at his wife. 

        
        
    d. Relevant Legal and Behavioral history (pre-military, military, and
       post-military):
      
         States he got a DUI in 1995, was reduced in rank for the DUI, but he
         denies any other arrests or major legal or behavioral problems before,
         during, or since his service in the military.
        
    e. Relevant Substance abuse history (pre-military, military, and
       post-military):
      
         States he started drinking in excess in about 1993 (no excessive
alcohol
         use prior to the military), got a DUI in 1995, was reduced in rank for
         the DUI and sent to alcohol abuse treatment (3-4 appointments), states
         he continues to use alcohol, but he denies any excessive alcohol use
         since his DUI, denies that he drinks and drives, denies any other
         occupational or legal problems due to alcohol use, and he denies any
         other substance use  problems before, during, or since his service in
         the military.
        
    f. Other, if any:
       No response provided.
      
    3. Symptoms
    -----------
    For VA rating purposes, check all symptoms that actively apply to the
    Veteran's diagnoses:
   
       [X] Anxiety
       [X] Panic attacks that occur weekly or less often
       [X] Chronic sleep impairment
       [X] Mild memory loss, such as forgetting names, directions or recent
           events
       [X] Disturbances of motivation and mood
       [X] Difficulty in adapting to stressful circumstances, including work or
a
           worklike setting

    4. Behavioral observations
    --------------------------
    The Veteran arrived at his exam appointment on time. He was dressed
casually,
    appears to have good grooming and hygiene, demonstrated no evidence of
    thought disorder or gross cognitive or memory deficits, made appropriate eye
    contact, and was cooperative and alert and oriented during the exam. His
mood
    and affect appeared euthymic and generally, and he denies any current
    significant depression or any history of suicidal ideation, suicidal
    gestures/attempts, or psychiatric admissions, also denies any history of
    homicidal ideation or intent, manic/hypomanic symptoms, or psychotic
symptoms
    (no auditory/visual hallucinations or delusions), and he demonstrated no
    behaviors consistent with these symptoms during the exam.
     
    The Veteran was given a brochure containing information about mental health
    and medical treatment resources for Veterans (includes suicide/crisis
hotline
    information) during the exam and was encouraged to seek mental health
    treatment through the San Diego VA if he feels treatment is needed. He was
    also strongly encouraged to go to the nearest emergency room and to call the
    suicide hotline in the event that he begins to have suicidal ideation in the
    future.
   
   
    5. Other symptoms
    -----------------
    Does the Veteran have any other symptoms attributable to mental disorders
    that are not listed above?
    [ ] Yes  [X] No
   
    6. Competency
    -------------
    Is the Veteran capable of managing his or her financial affairs?
    [X] Yes  [ ] No
   
    7. Remarks (including any testing results), if any:
    ---------------------------------------------------
    ADLs: The Veteran reports that he is currently able to manage his own
    finances and other important activities of daily living (denies any current
    problems with personal hygiene/grooming, cleaning, shopping, cooking, etc.).
      
    Per Veteran's 2507:
    **CLAIM TYPE: ORIGINAL
    **SPECIAL CONSIDERATIONS: NOT APPLICABLE
    **INSUFFICIENT EXAM: NO

    ELECTRONIC CLAIMS FOLDER AVAILABLE.
    CLAIMS FILE BEING SENT FOR REVIEW BY THE EXAMINER.

    An in-person examination is required for the following exam(s). ACE process
    must not be used to complete the DBQ.

    DBQ PSYCH Mental disorders

    The following contentions need to be examined:
    ADJUSTMENT DISORDER

    DBQ PSYCH Mental disorders:

    Please review the Veteran's electronic folder in VBMS and state that it was
    reviewed in your report.

    MEDICAL OPINION REQUEST

    TYPE OF MEDICAL OPINION REQUESTED: Secondary Service connection.

    OPINION REQUESTED: Secondary Service Connection.

    Is the Veteran's ADJUSTMENT DISORDER at least as likely as not (50 percent
    or greater probability) proximately due to or the result of tinnitus?

    Rationale must be provided in the appropriate section. Your review is not
    limited to the evidence identified on this request form, or tabbed in the
    claims folder. If an examination or additional testing is required, obtain
    them prior to rendering your opinion.

    POTENTIALLY RELEVANT EVIDENCE:

    NOTE:  Your (examiner) review of the record is NOT restricted to the
    evidence listed below.  This list is provided in an effort to assist the
    examiner in locating potentially relevant evidence.

    Tab A (Federal treatment record in VBMS): Bremerton CBOC (Ajustment Disorder

    Diagnosis) dated 05/10/2016

    Tab B (Federal treatment record in VBMS): CAPRI Records -- Seattle VAMC
    dated 05/23/2016

    If more than one mental disorder is diagnosed please comment on their
    relationship to one another and, if possible, please state which symptoms
    are attributed to each disorder.

    Exam Findings:
    The Veteran was verbally notified that this evaluation is for compensation
    and pension purposes only and that he should see his treating clinician for
    regular psychiatric care.

    The Veteran's symptoms are not consistent with an adjustment disorder
    (symptoms not due to difficulty adjusting to a specific stressor). His
    symptoms are most consistent with DSM-5 criteria for a diagnosis of
    Unspecified Anxiety Disorder (transient, moderately severe symptoms of
    anxiety that had onset after the military/approx 10 years ago). His anxiety
    currently causes marked distress and mild impairment in occupational and
    social functioning (due primarily to irritability and impatience at work and
    at home, fatigue, concentration/short-term memory issues).

    The Veteran reports having sleep disturbance which he feels is due to his
    Tinnitus. Although his tinnitus likely plays a role in his insomnia, he has
a
    diagnosis of obstructive sleep apnea and does not find his C-PAP machine to
    be very helpful. He also has anxiety. It is my opinion that his
    insomnia/sleep disturbance is primarily due to sleep apnea (which is a
    medical condition) and is excacerbated by tinnitus and his anxiety. 
   

****************************************************************************

                                 Medical Opinion
                        Disability Benefits Questionnaire

   
   
    ACE and Evidence Review
    -----------------------
    Indicate method used to obtain medical information to complete this
document:
   
    [X] In-person examination
   

    Evidence Review
    ---------------
    Evidence reviewed (check all that apply):
   
    [X] VA e-folder (VBMS or Virtual VA)

    MEDICAL OPINION SUMMARY
    -----------------------
    RESTATEMENT OF REQUESTED OPINION:

    a. Opinion from general remarks: **CLAIM TYPE: ORIGINAL
    **SPECIAL CONSIDERATIONS: NOT APPLICABLE
    **INSUFFICIENT EXAM: NO

    ELECTRONIC CLAIMS FOLDER AVAILABLE.
    CLAIMS FILE BEING SENT FOR REVIEW BY THE EXAMINER.

    An in-person examination is required for the following exam(s). ACE process
    must not be used to complete the DBQ.

    DBQ PSYCH Mental disorders

    The following contentions need to be examined:
    ADJUSTMENT DISORDER

    DBQ PSYCH Mental disorders:

    Please review the Veteran's electronic folder in VBMS and state that it was
    reviewed in your report.

    MEDICAL OPINION REQUEST

    TYPE OF MEDICAL OPINION REQUESTED: Secondary Service connection.

    OPINION REQUESTED: Secondary Service Connection.

    Is the Veteran's ADJUSTMENT DISORDER at least as likely as not (50 percent
    or greater probability) proximately due to or the result of tinnitus?

    Rationale must be provided in the appropriate section. Your review is not
    limited to the evidence identified on this request form, or tabbed in the
    claims folder. If an examination or additional testing is required, obtain
    them prior to rendering your opinion.

    POTENTIALLY RELEVANT EVIDENCE:

    NOTE:  Your (examiner) review of the record is NOT restricted to the
    evidence listed below.  This list is provided in an effort to assist the
    examiner in locating potentially relevant evidence.

    Tab A (Federal treatment record in VBMS): Bremerton CBOC (Ajustment Disorder

    Diagnosis) dated 05/10/2016

    Tab B (Federal treatment record in VBMS): CAPRI Records -- Seattle VAMC
    dated 05/23/2016

    If more than one mental disorder is diagnosed please comment on their
    relationship to one another and, if possible, please state which symptoms
    are attributed to each disorder.

 

 

    b. Indicate type of exam for which opinion has been requested: Mental
    Disorders

    TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR SECONDARY SERVICE
    CONNECTION ]

    b. The condition claimed is less likely than not (less than 50%
    probability) proximately due to or the result of the Veteran's service
    connected condition.  

    c. Rationale: The Veteran's symptoms are not consistent with an adjustment
    disorder (symptoms not due to difficulty adjusting to a specific stressor).
    His symptoms are most consistent with DSM-5 criteria for a diagnosis of
    Unspecified Anxiety Disorder (transient, moderately severe symptoms of
    anxiety that had onset after the military/approx 10 years ago, and treatment
    records show he has had confusion about what the trigger for initial onset
of
    his anxiety may have been).

    The Veteran also reports having sleep disturbance which he feels is due to
    "continuous" Tinnitus. Although his tinnitus likely plays a role in his
    insomnia, he has a diagnosis of obstructive sleep apnea and does not find
his
    C-PAP machine to be very helpful. He also has anxiety. It is my opinion that
    his insomnia/sleep disturbance is primarily due to sleep apnea (which is a
    medical condition) and is excacerbated by tinnitus and his anxiety. 

    TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR AGGRAVATION OF A
    NONSERVICE CONNECTED CONDITION BY A SERVICE CONNECTED CONDITI0N ]

    a. Can you determine a baseline level of severity of (claimed
    condition/diagnosis) based upon medical evidence available prior to
    aggravation or the earliest medical evidence following aggravation by
    (service connected condition)?  Yes

    ii. Provide the date and nature of the medical evidence used to provide the
    baseline:   It is my opinion that although tinnitus is not likely the cause
    of his anxiety or his sleep disturbance, the tinnitus likely
    exacerbates/aggravates his anxiety and insomnia beyond their natural
    progression. 

    *************************************************************************

 

 

[broncovet]

You need a nexus for service connection.  You can try an IME/IMO, but it wont fly until a doctor says your mental health disorder (list diagnosis, such as depression, PTSD, etc) is at least as likely as not due to xx event in military service. 

[Scotter04]

UPDATE: Got my BBE yesterday and as expected DENIED.  I understand why I was denied and can live with it for now. My first issue is how can a Psychologist opine, during my C&P,  that my NSC Sleep apnea and the fact that my CPAP doesn't help that much is the cause for my Insomnia and anxiety. Would that type of Medical opinion have to come from a Sleep specialist?  

My second issue is: I'm mainly trying to get my insomnia and anxiety secondary connected to my tinnitus and that is what my VA MH Dr. is treating me for. So, in the following paragraph wouldn't this constitute a nexus for secondary SC to Tinnitus?

The Veteran also reports having sleep disturbance which he feels is due to
    "continuous" Tinnitus. Although his tinnitus likely plays a role in his
    insomnia, he has a diagnosis of obstructive sleep apnea and does not find
his
    C-PAP machine to be very helpful. He also has anxiety. It is my opinion that
    his insomnia/sleep disturbance is primarily due to sleep apnea (which is a
    medical condition) and is excerbated by tinnitus and his anxiety.

 

One last thing I am in the process of sending of my FOIA for my C-File so do I send it to my RO (Seattle) or Janesville WIs?

 

Any and all responses will be greatly appreciated.

 

Scotter04